Despite outcry from Delaware retirees, Medicare Advantage plan will start in 2023

[Northeast Agent]

Delaware Medicare Advantage plan to start in 2023 despite concerns

The letter also noted new changes to the Medicare Advantage plans, which lawmakers wrote came as a result of “input in recent weeks.” In addition to the brief delay of prior authorization, Highmark will provide quarterly reports on denial and approval rates and expand out-of-network access, which has been a particular worry for retirees.

 

[somarco]

MA plans save money for them (city, county, state, AND Medicare) . . . but not necessarily for the beneficiary. The plan sponsor also has more control over future costs (to them, not the beneficiary).

What's not to love (for the plan sponsor)?

 

[Truce]

From the letter to the DE Governor by the state legislators who voted for this change:
We do request you seek additional protections and supports for retirees, including:
• contractual language for performance guarantees beyond data reporting requirements.
For example, although data transparency is critical, we want to ensure retirees are entitled
to relief if the rates of pre-authorization denials or delays raise concerns as to the quality
of care they receive, or if individual denials or delays are unjustifiable and result in any
harm.
• the hiring of qualified, dedicated staff at the Department of Human Resources to help
answer questions and work with retirees navigating a new relationship with Highmark in
the pre-authorization process or experiencing other access concerns. Retirees already are
accustomed to working directly with DHR staff to address health plan questions, and we
believe it is important to maintain that support even as Highmark develops its own
internal processes.

I understand that certain benefits have been collectively bargained and real changes may have to start with new employees, but why are these broke states are still in the business of supplying comprehensive benefits and guidance for post 65 retirees? Let retirees enroll in their own MAPD/ Med supp and the states can help pay their part B (NJ even pays the lifetime IRMAA for many retirees and spouses...I kid you not!). Give retirees assistance for drugs as a flex card now that there will be a federal max, as Part D was always the big differentiator between public and private benefits.

Medicare is well administered at the federal level. Really, it's done well and people are pretty happy with it. There are lots of agents to help people with it. The states have other things to worry about.